Provider Demographics
NPI:1972606275
Name:HECTOR Y RODRIGUEZ PC
Entity Type:Organization
Organization Name:HECTOR Y RODRIGUEZ PC
Other - Org Name:ADVANCE UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-779-2133
Mailing Address - Street 1:15138 LEVAN RD
Mailing Address - Street 2:SUITE 38
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5027
Mailing Address - Country:US
Mailing Address - Phone:734-779-2133
Mailing Address - Fax:734-779-2154
Practice Address - Street 1:15138 LEVAN RD
Practice Address - Street 2:SUITE 38
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5027
Practice Address - Country:US
Practice Address - Phone:734-779-2133
Practice Address - Fax:734-779-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050645208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4072034OtherAETNA
MIP41692OtherBLUE CARE NETWORK
MI126783OtherPREFERRED CHOICES
MI340H231630OtherBLUE CROSS BLUE SHIELD
MI340018996OtherRAILROAD MEDICARE
MI123783OtherCARE CHOICES
MIA74262Medicare UPIN
0P50340Medicare PIN